Hyperhemolysis Syndrome in a Patient with Sickle Cell Disease: A Case Report.

Clin Pract Cases Emerg Med

USF Morsani College of Medicine, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania.

Published: February 2021

Introduction: Hyperhemolysis syndrome (HHS) is a rare complication of repeat blood transfusions in sickle cell disease (SCD). This can occur acutely or have a delayed presentation and often goes unrecognized in the emergency department (ED) due to its rapid progression and similarity to acute chest syndrome and other common complications of SCD.

Case Report: We present a case of a 20-year-old male with SCD who presented to the ED with pain and tenderness in his lower extremities one day after discharge for a crisis. Unbeknownst to the ED team, during his admission he had received a blood transfusion. On presentation he was noted to have hyperkalemia, hyperbilirubinemia, anemia, and uncontrolled pain, and was admitted for sickle cell pain crisis. Over the next 36 hours, his hemoglobin dropped precipitously from 8.9 grams per deciliter (g/dL) to 4.2 g/dL (reference range: 11.5-14.5 g/dL), reticulocyte count from 11.7 % to 3.8% (0.4-2.2%), and platelets from 318,000 per cubic centimeter (K/cm) to 65 K/cm (140-350 K/cm). He also developed a fever, hypoxia, transaminitis, a deteriorating mental status, and severe lactic acidosis. Hematology was consulted and he was treated with methylprednisolone, intravenous immunoglobulin, two units of antigen-matched red blood cells, fresh frozen plasma, and cryoprecipitate. He was transferred to an outside hospital for exchange transfusion and remained hospitalized for 26 days with acute liver failure, bone marrow necrosis, and a fever of unknown origin.

Conclusion: Because of the untoward outcomes associated with delay in HHS diagnosis and the need for early initiation of steroids, it is important for emergency providers to screen patients with hemoglobinopathies for recent transfusion at ED presentation. Asking the simple question about when a patient's last transfusion occurred can lead an emergency physician to include HHS in the differential and work-up of patients with sickle cell disease complications.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872616PMC
http://dx.doi.org/10.5811/cpcem.2020.12.50349DOI Listing

Publication Analysis

Top Keywords

sickle cell
16
cell disease
12
hyperhemolysis syndrome
8
transfusion presentation
8
syndrome patient
4
sickle
4
patient sickle
4
cell
4
disease case
4
case report
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!